Psychosocial predictors and moderators of weight management programme outcomes in ethnically diverse obese youth

Abstract

Background: An important area of research in childhood obesity is the identification of factors that predict or moderate the responses to obesity intervention programmes, yet few studies have examined the impact of self-esteem and family functioning on obesity treatment outcomes.

Objectives: We sought to determine whether baseline self-esteem and family functioning predicted or moderated childhood obesity intervention outcomes at 6 months.

Methods: From 2009 to 2011, seventy-five 10-16 year old, racially/ethnically diverse obese youths with abnormal glucose tolerance were randomized to 6 months of an intensive family-based obesity lifestyle intervention (Bright Bodies) or routine outpatient Clinic Care. We examined youth self-concept, parent-rated family functioning and 6-month outcomes (youths' glucose tolerance, weight, body mass index and percent fat). We set the significance threshold as P ≤ 0.05 for moderator and predictor analyzes.

Results: Having poor family functioning and self-concept scores indicating high anxiety and low self-esteem at baseline predicted poor 6-month outcomes overall (Bright Bodies and Clinic Care groups combined). Additionally, baseline self-esteem and family functioning moderated treatment effects such that Bright Bodies outperformed Clinic Care in youths with low self-esteem and poorly functioning families, whereas youths with high self-esteem and high-functioning families did similarly well with either intervention.

Discussion: Our findings suggest intensive family-based lifestyle programmes are particularly beneficial for youth with low self-esteem and poorly functioning families.

Trial registration: ClinicalTrials.gov NCT01030978.

Keywords: adolescents; children; clinical trial; obesity.

Conflict of interest statement

Conflict of Interest Statement: There are no conflicts of interest.

© 2016 World Obesity Federation.

Figures

Figure 1

Moderation of Treatment Effects by Piers-Harris Children’s Self-Concept Subscales: (a) Physical Appearance and Attributes, (b) Intellectual and School Status, (c) Happiness and Satisfaction. When the 95% CI is below zero, Bright Bodies (BB) outperformed Clinic Care (CC), except for WBISI (whole-body insulin sensitivity index) because an increase in WBISI is good, whereas increases in all other outcomes are bad. aLog transformed. Abbreviations: BMI, body mass index; CI, confidence interval; LSMeans, least square means.

Figure 2

Moderation of Treatment Effects by McMaster Family Assessment Device (FAD) Subscales:a (a) Family Problem Solving and (b) Family Communication. When the 95% CI is below zero, Bright Bodies (BB) outperformed Clinic Care (CC). aHigher scores indicate poorer family functioning. Abbreviations: BMI, body mass index; CI, confidence interval; LSMeans, least square means.